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Meta-Analysis
. 2022 Mar 14;12(1):4366.
doi: 10.1038/s41598-022-08447-y.

Determinants of emergency presentation in patients with colorectal cancer: a systematic review and meta-analysis

Allan M Golder  1 , Donald C McMillan  2 , Paul G Horgan  2 , Campbell S D Roxburgh  2
Affiliations
Meta-Analysis

Determinants of emergency presentation in patients with colorectal cancer: a systematic review and meta-analysis

Allan M Golder et al. Sci Rep. .

Abstract

Colorectal cancer remains a significant cause of morbidity and mortality, even despite curative treatment. A significant proportion of patients present emergently and have poorer outcomes compared to elective presentations, independent of TNM stage. In this systematic review and meta-analysis, differences between elective/emergency presentations of colorectal cancer were examined to determine which factors were associated with emergency presentation. A literature search was carried out from 1990 to 2018 comparing elective and emergency presentations of colon and/or rectal cancer. All reported clinicopathological variables were extracted from identified studies. Variables were analysed through either systematic review or, if appropriate, meta-analysis. This study identified multiple differences between elective and emergency presentations of colorectal cancer. On meta-analysis, emergency presentations were associated with more advanced tumour stage, both overall (OR 2.05) and T/N/M/ subclassification (OR 2.56/1.59/1.75), more: lymphovascular invasion (OR 1.76), vascular invasion (OR 1.92), perineural invasion (OR 1.89), and ASA (OR 1.83). Emergencies were more likely to be of ethnic minority (OR 1.58). There are multiple tumour/host factors that differ between elective and emergency presentations of colorectal cancer. Further work is required to determine which of these factors are independently associated with emergency presentation and subsequently which factors have the most significant effect on outcomes.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
PRISMA statement.
Figure 2
Figure 2
Association between tumour location (rectal vs colonic) and emergency presentation—Forest Plot.
Figure 3
Figure 3
Association between colonic tumour location (right sided vs left sided) and emergency presentation—Forest Plot.
Figure 4
Figure 4
Association between overall tumour staging and emergency presentation—Forest plot.
Figure 5
Figure 5
Association between T Stage and emergency presentation—Forest Plot.
Figure 6
Figure 6
Association between N Stage and emergency presentation—Forest Plot.
Figure 7
Figure 7
Association between M Stage and emergency presentation—Forest Plot.
Figure 8
Figure 8
Association between presence of lymphovascular invasion and emergency presentation—Forest Plot.
Figure 9
Figure 9
Association between presence of vascular invasion and emergency presentation—Forest Plot.
Figure 10
Figure 10
Association between presence of perineural invasion and emergency presentation—Forest Plot.
Figure 11
Figure 11
Association between tumour grade/differentiation and emergency presentation—Forest Plot.
Figure 12
Figure 12
Association between sex and emergency presentation—Forest Plot.
Figure 13
Figure 13
Association between ethnicity and emergency presentation—Forest Plot.
Figure 14
Figure 14
Association between ASA Grade and emergency presentation—Forest Plot.
Figure 15
Figure 15
Summary of meta-analysis findings—association between clinicopathological characteristics and emergency presentation (odds rations and 95% confidence intervals).
See this image and copyright information in PMC

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